Current diagnostic and therapeutic approaches for colorectal cancer liver

Hippokratia 2008; 12 (3): 132-138

KA Paschos, N Bird

Abstract

Colorectal cancer is the second leading cause of cancer death in the developed world, due to formation of distant metastases. The liver is a primary target organ of metastatic lesions, which substantially influence the morbidity of the disease. Prompt diagnosis of colorectal liver metastases leads to early treatment, which favours a better prognosis.
Consequently, the diagnostic process has shifted from traditional clinical and biochemical procedures to technologically advanced imaging modalities, such as CT, MRI, FDG-PET and PET-CT. However, the only current curative therapeutic approach is the surgical resection of metastases, using the new methods of tissue excision and haemostasis. New therapeutic modalities like cryo- or radiofrequency ablation and portal vein embolisation as well as pharmaceutical innovations such as hepatic arterial infusion chemotherapy, isolated hepatic perfusion and contemporary chemotherapeutic regimens have emerged. While still under evaluation, they present promise for the future treatment of unresectable liver metastases.

Read PDF

Read more...

Clear cell ovarian carcinoma following polymyositis diagnosis: a case report and review of the literature

Hippokratia 2008; 12 (3): 181-185

I. Kalogiannidis, A. Papanikolaou, I. Xanthakis, A. Makedos, N. Prapas

Abstract

Background: The association of ovarian malignancy with dermatomyositis (DM) is well established from previous reports, while the relationship with polymyositis (PM) is rare.
Case report: We report a case of a 50 years old nulliparous woman who developed clear cell ovarian cancer four years after the PM diagnosis. The patient presented with deep lower abdominal pain and distension. CA-125 was elevated and the preoperative MRI showed pelvic tumor occupying the Douglas pouch. Exploratory laparotomy revealed a gross mass of clear cell ovarian carcinoma.
Conclusion: Physicians must be alert of the possibility of malignancy in patients with a previous diagnosis of polymyositis.

Read PDF

Toxoplasmosis during pregnancy: a case report and review of the literature

Hippokratia 2008; 12 (3): 139-143

C. Giannoulis, B. Zournatzi, A. Giomisi, E. Diza, I. Tzafettas

Abstract

Although toxoplasmosis is considered harmless for a non-pregnant woman, it is potentially harmful during pregnancy, especially at first trimester. The aim of this study is to increase our alertness and monitoring in case of toxoplasmosis during pregnancy, given that when diagnosed it can be effectively treated. We present a case of a healthy 26 years old adult woman, found with toxoplasmosis during the 13th week of pregnancy. The role of frequent maternal and fetus immunological tests, PCR-tests of the amniotic fluid and ultrasound screening of the fetus throughout pregnancy was of great value. The patient was treated with spiramycin (1gr x 3) from the 16th week of pregnancy. The patient was subjected to cesarean delivery at the 36th week of pregnancy due to preterm contractions and history of previous cesarean delivery. The newborn was a healthy girl with a birth weight of 2880 gr. A two-year follow up of the baby revealed no medical condition. Maternal infections are a serious medical condition during pregnancy. Toxoplasmosis when diagnosed on time and treated properly can lead to healthy offspring.

Read PDF

Periodontitis as a risk factor for cardiovascular disease: The role of anti-phosphorylcholine and anti-cardiolipin antibodies

Hippokratia 2008; 12 (3): 144-149

K. Karnoutsos, P Papastergiou, S. Stefanidis, A. Vakaloudi

Abstract

Available evidence does allow an interpretation of periodontitis as being a risk factor for atherosclerosis and coronary heart disease. There is now a convincing body of evidence that mechanism of atherosclerosis has a major inflammatory component and it is much more than the simple accumulation of lipids on the vascular walls. Studies have shown that certain other mild bacterial infections consist a major risk factor for stroke in young and middle aged patients. Several possible mechanisms could explain the observed association between infection and infraction. The evidence supports the premise that periodontitis leads to systemic exposure to oral bacteria and that the resulting production of inflammatory mediators is capable of initiating or supporting mechanisms associated to development of atherosclerosis and coronary heart disease. Studies in patients with pathologic concentrations of anti-cardiolipin and anti-phosphorylcholine antibodies demonstrated increased pocket depth and attachment loss, compared to patients with normal levels of the above antibodies. These antibodies could be associated to increased risk for stroke and atherosclerosis in patients with periodontitis. As we become more familiar to the association between periodontitis and cardiovascular disease it is likely that in the future periodontal disease may be added to the list of the factors which are used to assess patients’ risk profile for coronary heart disease and stroke.

Read PDF

Synchronous and metachronous adenocarcinomas of the large intestine

Hippokratia 2008; 12 (3): 150-152

N. Tziris, J. Dokmetzioglou, K. Giannoulis, I. Kesisoglou, K. Sapalidis, E. Kotidis, O. Gambros

Abstract

Background and aim: The synchronous and consecutive (metachronous) development of two or more primary adenocarcinomas accounts for 3 to 5 % of cases of colorectal cancer. Aim of this study is to review our experience in the management of patients with synchronous and metachronous lesions, and reach conclusions regarding their optimal diagnosis, treatment and follow-up. Patients and methods: Between 1987 and 2004, 12 patients (seven men and five women, mean age 67.5 years, range 47-83 years) with synchronous (three patients) and metachronous (nine patients) lesions were treated, comprising 4.3% of all patients submitted to surgery for colorectal cancer. The diagnosis lag for metachronous lesions ranged from 1.5 to 14 years. All three patients with synchronous cancers had two lesions. Results: Staging colonoscopy and abdominal CT was conducted in 10 patients while the remaining two underwent only abdominal CT due to their critical condition at presentation. Surgery had curative intent in 10 patients and palliative in two. The mean postoperative hospital stay was 21 days (10 – 49 days). The postoperative mortality was zero. Patients survival after curative procedures was 80% for the first year, 60% for the third and 50% for the fifth year. After palliative surgery, survival was 50% for the first year, and zero for the third. Conclusions: Patients with colorectal cancer must be followed up regularly after surgery. Follow up aims at early diagnosis and treatment of metachronous lesions that can appear many years after diagnosis of the primary lesion. Preoperative colonoscopy is an invaluable diagnostic (biopsy) and staging (exclusion of synchronous lesions, localization of the primary) modality, dictating the surgical approach. Additionally, it contributes to cancer prevention allowing the discovery and removal of small polyps before their transformation.

Read PDF

Relationship between inflammatory cytokines and cardiorenal anemia syndrome:Treatment with recombinant human erythropoietin (rhepo)

Hippokratia 2008; 12 (3): 153-156

G. Perunicic-Pekovic, S. Pljesa, S. Rasic, L J. Komadina, R. Markovic, L J. Lambic, D. Celeketic

Abstract

Background and aim: Hemodialysis (HD) patients are exposed to persistent inflammatory state. Erythropoietin resistance is known to be strongly associated with chronic inflammation. Aim of the study was to analyze the effect of elevated inflammatory markers on hemoglobin levels and rhEPO requirements in stable patients of our hemodialysis center.
Patients and methods: The study population consisted of 42 patients, 19F/23M, mean age 54.5�12.0 years. C-reactive protein (CRP), interleukin-6 (IL-6), hemoglobin (Hb), ferritin and left ventricular mass index (LVMi) were recorded. Group 1 consisted of 10 patients with Hb ≤ 10 g/dl, mean 8.3�1.2 g/dl and Group 2, of 10 patients with Hb ≥ 10 g/dl, mean 12.6�1.91 g/dl. None of these 20 patients had been previously treated with rhEPO. Group 3 consisted of 22 patients with mean Hb 10.1�1.5 g/dl after treatment with rhEPO.
Results: Group 1 patients had significanty higher IL-6 concentrations than Group 2 (5.21�3.94 vs 3.03�3.64, p < 0.03). Group 3, treated with rhEPO had IL-6 concentrations significantly lower compared to Group 1 (1.15�3.81 vs 3.03�3.64, p < 0.05). HD pts in Group 1 presented significantly higher CRP concentrations compated to pts of Group 2 and 3 (23.1�9.1 vs 7.02�8.7 and 7.89�9.6 respectivly, p < 0.05). A negative correlation was demonstrated between IL-6 and Hb level (r: 0.33 p < 0.05).
Conclusions: A better management of anemia might improve inflammatory state and survival in this population.

Read PDF

The effect of recombinant human erythropoietin treatment on insulin resistance and inflammatory markers in non-diabetic patients on maintenance hemodialysis

Hippokratia 2008; 12 (3): 157-161

Z. Rasic-Milutinovic, G. Perunicic-Pekovic, A. Cavala, Z. Gluvic, S. Bokan, S. Stankovic

Abstract

Background and aim: Iron overload and inflammation might participate in the pathogenesis of insulin resistance in community. The improvement of insulin resistance in hemodialysis (HD) patients is frequently seen after correction of anemia. The aim of this study was to investigate the influence of recobinant humam erythropoietin (Epo) treatment on insulin resistance in non-diabetic HD patients.
Patients and methods: We investigated the effects of 6 months-duration treatment with Epo on insulin resistance and inflammatory parameters in 16 (6 male/10 female) patients on maintenance HD with renal anemia (hemoglobin concentration ≤105 g/l). The control group consisted of 15 patients on HD with renal anemia, without Epo treatment. Further clinical and laboratory variables were observed: fasting blood glucose (FBG), insulin, albumin, iron, total iron binding capacity (TIBC), transferrin saturation (TSAT), ferritin, TNF-alpha, and IL-6. Independent predictors for changes of calculated insulin resistance index by homeostasis model assessment (HOMA-IR) were identified by multivariate linear regression analysis.
Results: A significant reduction of insulin levels and therefore significant lowering of HOMA-IR was registered in Epo treated group. It was observed improvement of anemia [Hb 93.90�17.34 g/L vs. 116.40�21.03 g/L, p: 0.01; Hct 0.28 (0.24-0.31) vs. 0.33% (0.31-0.37), p: 0.01] as well as a trend toward iron stores decrease [ferritin 466.45 (174.40-886.90) vs. 279 ?g/L (137.00-648.50), p: 0.06]. A significant decrease of TNF-alpha [2.30 pg/ml (1.48-2.95) vs. 1.65 pg/ml (0.11- 1.96), p: 0.01] and IL6 levels [8.32 pg/ml (2.31-9.83) vs. 2.60 pg/ml (2.00-3.05), p: 0.01] was presented. After adjustment for confounding variables (age, sex, and Kt/v), a model consisting of BMI, ferittin, and TNF alpha accounted for 96% of the variance in HOMA-IR in Epo treated patients.
Conclusions: The present study demonstrated that Epo treatment could participate in reducing insulin resistance through iron stores reduction and improvement of chronic inflammation in patients on maintenance HD.

Read PDF

Abnormal glyceraldehyde-3-phosphate dehydrogenase binding and glycolytic flux in Autosomal Dominant Polycystic Kidney Disease after a mild oxidative stress

Hippokratia 2008; 12 (3): 162-167

C. Dioudis, D. Grekas, TH. Thomas, IC. West

Abstract

Aim: The aim of this study was, a) to investigate the effect of mild oxidative stress on glycolytic flux and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) binding in erythrocytes from patients with autosomal dominant polycystic kidney disease (ADPKD), and b) to examine whether the modulation of GAPDH-binding to the red cell membrane leads to changes in glycolytic flux.
Patients and methods: The rate of lactate production in intact erythrocytes and the GAPDH/actin ratio in erythrocyte ghost membranes were measured before and after treating cells with t-butyl hydroperoxide or N-ethylmaleimide (NEM) in 13 ADPKD patients and 12 controls.Results: t-bytyl hydro-peroxide had a significant effect on both lactate production and GAPDH/actin ratio in healthy subjects, but it had essentially no effect on ADPKD patients in which both parameters already resembled those of the peroxide-treated controls. NEM treatment after 300 sec had a very significant effect on both lactate production and GAPDH/actin ratio in both patient and control cells. However, after 10 sec the effect on GAPDH/actin ratio was only significant in the erythrocytes of ADPKD patients. In every experiment glycolytic lactate production correlated negatively with membrane-bound GAPDH/actin ratio.Conclusions: We conclude that glycolytic flux and GAPDH binding in erythrocytes from ADPKD patients respond abnormally to both a mild oxidative stress and brief exposure to NEM.

Read PDF

Quality of life of children and adolescents with diabetes of Northern Greek origin

Hippokratia 2008; 12 (3): 168-175

E. Emmanouilidou, A. Galli-Tsinopoulou, A. Karavatos, S. Nousia-Arvanitakis

Abstract

Aim: To culturally adapt the diabetes- specific quality of life (QOL) instrument PedsQL 3.0 Diabetes Module (DM) and the generic QOL instrument PedsQL 4.0 Generic Core Scales (GCS) to the population of Greek diabetic children. Also, to evaluate QOL in youths with type 1 diabetes, compare it with that of healthy youths, and identify relationships between QOL and metabolic control and intensity of treatment.
Patients and Methods: Eighty nine (89) children and adolescents with type I diabetes and 89 without diabetes, all with their parents (2-18 years of age, diabetes duration >6 months) completed the Greek GCS. Those with diabetes also completed the Greek DM.
Results: Cronbach ? coefficient of child and parent report of both instruments, in general approached 0.70, indicating their internal consistency reliability. Both instruments demonstrated positive intercorrelations with their total scores and subscales of DM demonstrated positive intercorrelations with total score of the generic instrument, supporting the validity of both instruments for the evaluation of QOL of Greek diabetic children. No statistically important differences were found among patient and parent report of diabetes and control group in both instruments. Exception was “Social functioning” in which children with diabetes reported better QOL. Growing age, female gender, large BMI, poor metabolic control and intensity of treatment did not influence QOL of children with diabetes.
Conclusions: Greek PedsQL GCS and DM have sufficient acceptability, reliability and validity so as to be used for the purposes of a comparative study. Youth with diabetes reported similar QOL with non-diabetic youth of the same age and socioeconomic status.

Read PDF

Outcomes of kidney transplantation in Greek and Albanian patients: a single centre experience

Hippokratia 2008; 12 (3): 176-180

G. Vergoulas, I. Ioannidis, M. Nikodimopoulou, GR. Miserlis, F. Solonaki, E. Panou, L. Posa, J. Fousas, A. Papagiannis, V. Papanikolaou, D. Takoudas

Abstract

Background and aim: It has been reported that racial and ethnic (genetic make up), as well as socioeconomic differences may affect the results of kidney transplantation. Socioeconomic factors are quite difficult to differentiate from genetic factors. It is not surprising that a group with poorer access to health care, less private insurance and less income does less well with serious medical problems. The aim of this study was to compare the outcomes of kidney transplantations in Greek (G) and Albanian (A) patients.
Patiets and Methods: Twenty nine transplanted patients of Albanian ancestry were matched with 29 Greek patients retrospectively. Their mean age was 34 (G) and 31 (A) years, there were 21 men and 8 women in each group (G, A) and they received 26 kidneys from living related donors and 3 kidneys from cadaveric donors respectively. Arterial blood pressure (ABP), body weight (BW), serum creatinine, serum total protein and albumin, total cholesterol, HDL-cholesterol and triglycerides, 24 hour proteinuria were measured on 7th, 15th postoperative day, 1st , 3rd , 6th month and 1st year after transplant. BMI was calculated before and 1 year after transplantation and acute rejection episodes were recorded too. Methylprednizolone (MP), cyclosporine (CsA) dose /kg BW were calculated at baseline, 1, 3, 6, 12 months after transplant. Cumulative patient and graft survival at 1 and 5 years were calculated too.
Results: Patient survival at 1 and 5 years was 100% / 93.1% and 100% /93.1% respectively (p: NS). Graft survival at 1 and 5 years was 100% / 93.10% and 93.75% / 86.45% respectively (p: NS). BW (but not BMI) and total cholesterol levels in Greek patients were higher compared to those of Albanian patients during the 1st post transplant year (p: 0.044 and p: 0.021 respectively). MP dose in A patients was higher during the first year (p: 0.05).
Conclusion: Patients and graft survival do not present difference between G and A patients. There is significant difference on cholesterol profile between G and A patients. A larger number of transplants are possibly needed to allow us to draw firm conclusions.

Read PDF

Scarlet Fever and hepatitis: a case report

Hippokratia 2008; 12 (3): 186-187

D. Gidaris, D. Zafeiriou, P. Mavridis, N. Gombakis

Abstract

Scarlet fever is a streptococcal infection with a good prognosis. Complications are well described. Hepatitis is a rare complication. We describe a 6-year old boy with scarlet fever, jaundice and elevated liver transaminases.

Read PDF

Genetic polymorphism study of regulatory B cell molecules and cellular immunity function in an adult patient with Common Variable Immunodeficiency

Hippokratia 2008; 12 (3): 188-190

A. Sarantopoulos, K. Tselios, P. Skendros, D. Bougiouklis, I. Theodorou, P. Boura

Abstract

A 43 year old female patient presented for recurrent bacterial lower respiratory infections. A research for immunodeficiency status revealed total hypogammaglobulinemia, reduced IgG1, IgG2, IgG3 subclass levels, and low number of B lymphocytes (CD19+). Common Variable Immunodeficiency (CVID) 11.2 category was diagnosed according to recent criteria of primary immunodeficiencies (PID). Further immunological study consisting of genetic polymorphism of genes relating to differentiation, activation and function of B cells (ICOS, BAFF receptor BCMA and TACI) was performed, which did not reveal any related mutations. T cell parameters and Th1/Th2 cytokine network did not show any disturbances. It is postulated that probable endstage B cell differentiation defects should be investigated. The patient receives IVIGs replacement thereafter and the rate and severity of infections have significantly improved.

Read PDF

Current Issue 20 (1)